Posts Tagged ‘health policy’

The Truth About Ron Wyden’s Medicare Plan

August 21, 2012 1 comment

What You Should Know About Ron Wyden‘s Medicare Plan

On August 11th, GOP Presidential Candidate Governor Mitt Romney introduced Representative Paul Ryan as his choice for Vice President. Once this was announced, media outlets “freaked out” over the Medicare plan Senator Ron Wyden (D-OR) wrote with Representative Paul Ryan (R-WI, Chairman of U.S. House Budget Committee). The plan is a bipartisan plan officially called “The Guaranteed Choices to Strengthen Medicare and Health Security for All: Bipartisan Options for the Future” and it is a roadmap for how to strengthen and fix or failing Medicare system. Senator Wyden and Representative Paul focus their plan on choice, affordability, and protecting seniors. You can read more about the plan by clicking HERE


Starting in 2022, a new Medicare program will begin offering seniors a choice among private plans and the traditional Medicare plan – much like plans Members of Congress have. Any senior at or above age 55 today will see no changes in their Medicare. (Page 2)


Coverage will be guaranteed through a new “premium support” system that encourages plans to provide high-quality care more efficiently. Private plans will compete directly with traditional Medicare based on their ability to provide quality coverage at an affordable lower cost. Low-income seniors shopping for coverage would be offered the same range of high-quality options offered to all other seniors. They would be guaranteed the ability to choose a traditional fee-for- service Medicare plan, or they could choose a private plan on the Medicare Exchange with a fully- funded account from which to pay premiums, co-pays and other out-of-pocket costs. (Page 2,9)

Protecting Seniors
To ensure ample protection from scam-artists and bad actors, the program will not only require insurance coverage protections such as guaranteed issue and risk adjustment, but it will also require the Centers for Medicare and Medicaid Services (CMS) to actively review marketing practices and benefit adequacy. Plans that fail to comply with established standards of participation would have their contracts terminated. Building upon Medicare’s current marketing rules, all plans would also be required to have their marketing materials approved annually by CMS. (Page 2, 10)

Above are the facts of Senator Ron Wyden’s Medicare Plan. Keep in mind that is only a proposal and it can not become reality without passing Congress first. You can read more about the plan by clicking HERE


The Physicians Prescription for Health Care Reform

July 17, 2012 Leave a comment

In the U.S. Congress, there are currently 21 physicians.  The physicians are  Senator John Barasso,
Rep. Dan Benishek,Rep. John Boustany, Rep. Paul Broun, Rep. Michael Burgess, Rep. Larry Buschon, Rep. Bill Cassidy, Rep. Donna Christensen, Senator Tom Coburn, Rep. Scott DesJarlais, Rep. John Fleming, Rep. Phil Gingrey, Rep. Paul Gosar, Rep. Andy Harris, Rep. Nan Hayworth, Rep. Joe Heck, Rep. Jim McDermott, Senator Rand Paul, Rep. Ron Paul, Rep.Tom Price, and Rep. Phil Roe. One of the physicians is an anesthesiologist, one is a dentist, one is an emergency medicine physician, four are family practitioners, one is a gastroenterologist, four are obstetricians / gynecologists, one is a psychiatrist, and four are surgeons (cardiovascular, thoracic, general, and orthopedic). Below is a listing of bills and provisions the physicians have introduced  that includes their prescription for health care reform.


Bills by Physician

John Barrasso    –  S. 244   (State Health Care Choice Act)
Michael Burgess – H.R. 896  (Medical Justice Act)
Bill Cassidy          – H.R. 3315  (Direct M.D. Care Act)
Tom Coburn        – S. 1031        (Medicaid Improvement and State Empowerment Act)
Phil Gingrey        – H.R. 5       (Protecting Access to Healthcare Act)
Paul Gosar           – H.R. 1150  (Competitive Health Insurance Reform Act)
Joe Heck               – H.R. 2472  (Health Care Professionals Protection Act)
Jim McDermott  – H.R. 1256   (Medicare Physician Payment Transparency Act)
Ron Paul              – H.R. 147     (Prescription Drug Affordability Act)
Tom Price            – H.R. 969     (Medical Practice Freedom Act)


Key Provisions


Medical Practice Management Provisions

Cap on non-economic damages to health care practitioners and hospitals (Source 2)
Speedy resolution of health insurance claims (Source 5)
Restoring Anti-Trust Laws to Health Insurance Companies (Source 5)
Prohibit health entities from reporting professional review against health care professionals (Source 6)
People may import pharmaceutical drugs into U.S. if is approved by Secretary of Health and Human Services (Source 8)
Physicians not required to participate in any health insurance plan as a condition of licensure (Source 9)
Tax incentive for maintaining health care coverage (Source 10)
Financial incentive for treatment compliance (Source 10)
Student Loan forgiveness for primary care providers (Source 10)
Federally supported student loans for medical students (Source 10)


Medicare and Medicaid Provisions
Establish pilot program for monthly fee based direct primary care medical home Medicare and Medicaid enrollees (Source 3)
Require analytic contractors to review Medicare Physician Fee Schedule (Source 7)
Refundable tax credit for low-income individuals (Source 10)
Enforcement of Medicare Secondary Payment Provisions (Source 10)


State Health Care Provisions
States can opt out of provisions of Patient Protection and Accountable Care Act   (Source 1)
State incentive fund for medical malpractice reform (Source 4)
Grant to create health care tribunal (Source 10)
Track banned medical providers across state lines (Source 10)













U.S. House Votes to Repeal Healthcare Reform 244-185

July 11, 2012 1 comment

The U.S. House today voted to repeal the Affordable Care Act 244-185.  Five Democrats voted FOR repeal and they are:
Dan Boren (D-OK 02), Larry Kissell (D-NC 08), Jim Matheson (D-UT 02), Mike McIntyre (D-NC 07), Mike Ross (D-AR 04). You can see how each member of the House voted by going here: The bill the House approved (H.R. 6079) can be read here:

Keywords:  health care insurance, health care, health plan, health policy, U.S. Congress, health care reform

51% of Primary Care Physicians Stop Accepting Medicaid Patients

June 13, 2012 Leave a comment

Primary care physicians are struggling to survive in today’s economic climate. They of all the medical specialties have the lowest reimbursement rates and it is causing great harm to their bottom line. The fact that insurance  companies have been deliberately holding back reimbursement from physicians as well as continue to defraud Medicare and Medicaid in order to protect company profits does not help the matter either (Source 1). On the flip side of things, this is having a severely negative impact on patient access. According to a recent study released by Jackson Healthcare, 51% of physicians plan to no longer accept new Medicaid patients. In addition, 26% of primary care physicians have stopped accepting new Medicare patients (Source 2). Health and Human Services estimates that 13 million – 26 million will be new Medicaid enrollees thanks to the Affordable Care Act by 2020 (Source 3).  The private sector, states, and the federal government (HHS) need to fix this situation now before it gets any worse. Otherwise, we will have a huge crisis on our hands and thus no primary care physicians to care for Medicaid patients.





States dropping For-Profit Health Insurance Companies from Medicaid Programs

June 11, 2012 2 comments

As of today, The great state of Ohio has taken the right step and has kicked out private for -profit health insurance company Aetna from insuring people in Ohio’s Medicaid program. This comes only 2 months after Aetna received the green light to manage 1.7 million recipients. The contracts were supposed to go into effect January 1 of next year. It is unknown as to why Aetna was dropped (source 1).

Ohio is not the only state to have recently stopped awarding state Medicaid contracts to Aetna and other large 4-profit companies. In December 0f 2011, the great state of Connecticut made a great decision and kicked out UnitedHealthcare and Aetna from managing its Medicaid recipients as well. State officials are reported as saying to USA Today that the companies were dropped for “not fulfilling their promise to lower costs and provide better care.” (source 2). This whole thing of “not fulfilling their promise to lower costs and provide better care” is unfortunately becoming an epidemic in this country to when it comes to insurers. This goes ditto for the 4-profit ones. These especially are getting caught more and more by the federal government for defrauding Medicare and Medicaid on purpose in order to get profits for their shareholders. Sadly, this situation is turning into the “plague”.

According to research that I have done, I have found out that Aetna and UnitedHealthcare collectively have paid out over $596 million in settlements over the past 5 years for having been caught defrauding Medicare and Medicaid (actual amount defrauded before settlement to be posted on blog soon). Total amount by insurers over same time period is nearly $3,000,000,000 (source 3). This situation is clearly getting worse. State governments have finally “smelled the Starbucks” and have realized that the best prescription for curing this problem is to simply kick out the 4-profit companies from state Medicaid programs. Hopefully more states will follow suit and drop for-profit health insurance companies from their Medicaid programs.



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U.S. Congress Working to Replace Physician Sustainable Growth Rate

May 17, 2012 Leave a comment

The U.S. Congress is currently working on legislation to replace the physician sustainable growth rate. Since 2002, this has become a highly debated topic in Congress that has resulted in 14 CRs (short-term measure) being passed that were aimed to delay a 30% cut to physician Medicare payments. H.R. 5707 introduced and aimed at replacing the SGR.

To get things started, The U.S. Senate Finance Committee held a roundtable discussion on the matter last week. You can view the discussion at In a statement, Chairman Max Baucus (D-MT) said : “Medicare’s sustainable growth rate (SGR) formula has not worked as planned. The annual cuts the formula calls for have snowballed the problem.” Ranking member Orrin Hatch (R-UT) said in a statement: “We must provide a stable foundation for paying physicians today, not five or 10 years from now.”

On May 9, a billed aimed at replacing the SGR was introduced. H.R. 5707: Medicare Physician Payment Innovation Act of 2012 was officially introduced in the House by members Allyson Schwartz (D-PA, former hospital CEO) and Dr. Joe Heck ,DO (R-NV, physician). The bill can be read here: In order for the bill to be successful, it will need to have FULL support by all of the physicians in Congress. The physicians that need to be encouraged to pass it are: John Barrasso (R-WY), Tom Coburn (R-OK), Rand Paul (R-KY), Dan Benishek (R-MI), John Boustany (R-LA), Paul Broun (R-GA), Michael Burgess (R-TX), Larry Buschon (R-IN), Bill Cassidy (R-LA), Scott DesJarlais (R-TN), John Fleming (R-LA), Phil Gingrey (R-GA), Paul Gosar (R-AZ), Andy Harris (R-MD), Nan Hayworth (R-NY), Ron Paul (R-TX), Tom Price (R-GA), Phil Roe (R-TN), Donna Christensen (D-VI), and Jim McDermott (D-WA).

Stay tuned to this blog for further updates on this story.



Current Medical Professionals in The United States Congress

May 3, 2012 1 comment

Currently, there are 28 medical professionals in the United States Congress. When trying to get health policy initiative considered, they are the people who truly need to be contacted. I used to write federal healthcare policy for the U.S. Senate HELP Committee and I know the right way to reach them. I specifically help physicians contact them and I even recently helped an Internist contact and speak directly with 143 health legislative assistants ( who actually write healthcare bills), 5 members of Congress (Cooper, Conrad, Frank, Kucinich, Rangel), and two CMS officials about a new physician payment model he designed. If you are a physician and interested in learning how to best communicate with the physicians and nurses listed below, please contact me.


Nurses in U.S. House of Representatives

Diane Black (R-TN)                                           Karen Bass (D-CA)

Ann Buerkle (R-NY)                                           Lois Capps (D-CA)

Renee Ellmers (R-NC)                                       Berniece Johnson (D-TX)

Carolyn McCarthy (D-NY)


Physicians in U.S. Senate

John Barrasso  (R-WY)

Tom Coburn     (R-OK)

Rand Paul        (R-KY)


Physicians in U.S. House

Dan Benishek (R-MI)                                     Donna Christensen (D-VI)

John Boustany (R-LA)                                   Jim McDermott (D-WA)

Paul Broun (R-GA)

Michael Burgess (R-TX)

Larry Bucshon (R-IN)

Bill Cassidy (R-LA)

Scott DesJarlais (R-TN)

John Fleming (R-LA)

Phil Gingrey (R-GA)

Paul Gosar (R-AZ)

Andy Harris (R-MD)

Nan Hayworth (R-NY)

Joe Heck (R-NV)

Ron Paul (R-TX)

Tom Price (R-GA)

Phil Roe (R-TN)


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